Dementia is an increasingly common mental health disorder, with Alzheimer’s disease being the most common type of the condition [1]. It typically develops in adults over the age of 65, but it can affect adults of any age.
Dementia impacts a person’s memory and cognitive function, and can cause physical, psychological, and behavioral changes. It often emerges with mild symptoms and becomes increasingly worse, to the point where it may impair the person’s ability to live without constant support and assistance from others.
What is dementia aggression?
One change seen in people with dementia is an increase in anger and aggressive behaviors. This occurs in around half of all people with dementia, although this may vary depending on the dementia subtype someone is diagnosed with [2]. Often, as a person’s cognitive decline worsens, the aggressive behaviors they demonstrate will increase.
Dementia anger and aggression can be physical or verbal and are often directed at the person’s caregiver. This can cause issues in the way the caregiver is able to provide care. As a result, aggression can increase the discomfort of both the caregiver and the person with dementia [2][3].
Causes of anger and aggression in people with dementia
Emotional changes
Dementia can cause several emotional changes, such as depression, mania, fear, and agitation, all of which may increase distress and the risk of aggressive behaviors occurring [4].
Physical changes
There could be several reasons for anger that are related to physical changes a person experiences. For example, sleep and appetite can be greatly affected by aging and by dementia, so someone may become angry or aggressive when they are tired or hungry. [5].
Similarly, if the person is in pain, this could cause them to lash out in anger, particularly if they struggle to articulate the cause of this pain [5][6]. For people who require assistance with movement or may need some level of restraint, their pain may be exacerbated by this physical interaction, potentially causing them to react with aggression.
Relationship with caregiver
There is a great deal of research that suggests that the relationship between the person with dementia and their caregiver can have significant impacts on the development of verbal or physical aggression. Research suggests that an increase in caregiver burden directly affects the chance of agitation, depression, and aggression in their patient [6][7][8].
For instance, caregivers who have been attacked by the person they are caring for may feel an increase in the level of burden or fear they encounter. Whether knowingly or not, this can change their perception of the patient or the way in which they communicate, which could be noticeable and impactful to the patient’s behavior.
Environment
People with dementia may easily experience over or under stimulation [5]. For example, if they sit in the same chair with the same view for the majority of the day, they could feel under stimulated and bored, potentially causing an expression of aggression.
Similarly, they may feel over stimulated if they are surrounded by many people throughout the day, or are unable to be in a quiet, calming environment. This can also happen after a change in routine, for example a different feeding or sleeping time.
Psychotic symptoms
Dementia can cause psychotic symptoms, such as delusions and hallucinations. This can increase the chance of agitation and anger occurring, particularly if these delusions lead them to become suspicious of others around them [3].
For example, a person with dementia may believe someone is stealing from them, that their loved one has been replaced by an imposter, or that their partner is cheating on them. These suspicions may cause them to lash out at their caregiver or loved one.
Gender
Some research suggests that gender plays a part in the development of aggression in dementia, indicating that it may be more common in males [3].
Brain changes
Dementia causes a variety of changes in the brain, including the way in which certain neurotransmitters function. Some of these changes can cause feelings of anger, agitation, or depression [3].
Changes in the brain can also result in difficulty speaking or understanding others, which may cause frustration and lead to anger [5].
How to manage anger and aggression in people with dementia
Early intervention
First, try and find out if there is a clear trigger for their agitation or anger, such as physical discomfort, hunger, or loud noises, and try to resolve this if possible.
If there is no clear reason for their change in behavior, try to intervene as soon as signs of discomfort or agitation occur. You can utilize techniques such as relaxation or distraction before an escalation in emotion or behavior occurs.
Environmental changes
It may be that the person with dementia is becoming distressed because of something in the immediate vicinity, such as loud noises, too many people, or something on the television [5]. Reducing their anger may be as simple as changing the TV channel or helping them move to a different area of the house or outside.
Consult a specialist
Caring for a person with dementia can be challenging, especially as their condition worsens and if they begin to exhibit aggressive behaviors. You may wish to consult a specialist for help in managing their condition.
Occupational therapists (OTs) can help with day-to-day routines and mental stimulation, and assess the physical and environmental needs of the person with dementia. Their input could include therapeutic or calming activities, or making changes in the home for ease of movement, understanding, or communication [9].
Psychiatrists and mental health professionals can help with diagnosis and prescribing and administering medications.
Music therapy
Various studies suggest that music is able to help alleviate feelings of agitation and aggression in patients with dementia, within a group or just with the individual [10][11]. These studies also suggest that music therapy can help reduce the need for medications and help alleviate distress in these patients.
Try to play music that you know they enjoy, either from their past or something they have shown interest in recently. Singing along to this music can have even more positive effects and may encourage the patient to sing along with you [11].
Aromatherapy and touch therapy
Various studies have found that touch therapy and massage with the use of essential oils can help to reduce feelings of anger and agitation in patients with dementia [12][13][14]. However, it’s important to be very careful of skin sensitivities when using essential oils on the body. For this reason, it’s best to leave this to a licensed massage therapist or naturopathic doctor.
It is important to understand what the patient is comfortable with before beginning any kind of massage or touch therapy. You must gain their consent to use this intervention. Some may enjoy hair brushing, hand, arm, or neck massage, and the use of scented oils, such as lavender or eucalyptus.
Going outside
There is a great deal of evidence to suggest that being outside and engaging in exercise can help lift mood, and this is also true of anger within dementia [3][4]. Going for a walk or an outing with this person can help them feel calmer and happier.
Medication
It is widely accepted that medication should not be the first line of treatment for aggression and anger within dementia patients [3][4][15]. There is evidence to suggest that nonpharmacological approaches (intervention without medication) can be just as, if not more, useful in reducing distress [4][16].
Typically, older adults are at an increased risk of side effects and drug interactions from taking various medications. As such, medications should only be used when entirely necessary and the benefit is deemed to outweigh any associated risks [3]. Their doctor or health care provider can help weigh the risks against the potential benefits.
If a doctor does deem it necessary, they may prescribe the person with dementia one or more medications to help manage their symptoms.
This may include antidepressants, which can help reduce feelings of depression, irritability, and agitation, or antipsychotics to reduce aggression, agitation, and psychosis. It is important to note that antipsychotics can cause serious side effects and should be used with caution. Doctors may instead recommend anticonvulsant mood stabilizers since these medications target similar symptoms. Individuals with dementia may also benefit from short-term use of benzodiazepines to minimize acute instances of agitation and aggression [3][15].
- Centers for Disease Control and Prevention. (n.d). Alzheimer’s Disease and Healthy Aging: About Dementia. CDC. Retrieved from https://www.cdc.gov/aging/dementia/index.html
- Dettmore, D., Kolanowski, A., & Boustani, M. (2009). Aggression in Persons with Dementia: Use of Nursing Theory to Guide Clinical Practice. Geriatric Nursing, 30(1), 8-17. Retrieved from https://doi.org/10.1016/j.gerinurse.2008.03.001
- Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E.B. (2012). Behavioral and Psychological Symptoms of Dementia. Frontiers in Neurology, 3(73). Retrieved from https://doi.org/10.3389/fneur.2012.00073
- Collier, S. (2020). What’s the Best Way to Manage Agitation Related to Dementia? Harvard Health. Retrieved from https://www.health.harvard.edu/blog/whats-the-best-way-to-manage-agitation-related-to-dementia-2020021418816
- Alzheimer’s Association. (n.d). Aggression and Anger. Alzheimer’s Association. Retrieved from https://www.alz.org/help-support/caregiving/stages-behaviors/agression-anger
- Kunik, M.E., Snow, A.L., Davila, J.A., Steele, A.B., Balasubramanyam, V., Doody, R.S., Schulz, P.E., Kalavar, J.S., & Morgan, R.O. (2010). Causes of Aggressive Behavior in Patients with Dementia. The Journal of Clinical Psychiatry, 71(9), 1145–1152. Retrieved from https://doi.org/10.4088/JCP.08m04703oli
- Teri, L. (1997). Behavior and Caregiver Burden: Behavioral Problems in Patients with Alzheimer Disease and its Association with Caregiver Distress. Alzheimer Disease and Associated Disorders, 11(Suppl 4), S35–S38. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9339271/
- Kunik, M.E., Stanley, M.A., Shrestha, S., Ramsey, D., Richey, S., Snow, L., Freshour, J., Evans, T., Newmark, M., Williams, S., Wilson, N., & Amspoker, A.B. (2020). Aggression Prevention Training for Individuals With Dementia and Their Caregivers: A Randomized Controlled Trial. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 28(6), 662–672. Retrieved from https://doi.org/10.1016/j.jagp.2020.01.190
- Fraker, J., Kales, H.C., Blazek, M., Kavanagh, J., & Gitlin, L.N. (2014). The Role of the Occupational Therapist in the Management of Neuropsychiatric Symptoms of Dementia in Clinical Settings. Occupational Therapy in Health Care, 28(1), 4–20. Retrieved from https://doi.org/10.3109/07380577.2013.867468
- Choi, A-N., Lee, M.S., Cheong, K-J., & Lee, J-S. (2009) Effects of Group Music Intervention on Behavioral and Psychological Symptoms in Patients with Dementia: A Pilot-Controlled Trial, International Journal of Neuroscience, 119(4), 471-481, Retrieved from https://doi.org/10.1080/00207450802328136
- Ridder, H.M.O., Stige, B., Qvale, L.G., & Gold, C. (2013). Individual Music Therapy for Agitation in Dementia: An Exploratory Randomized Controlled Trial. Aging & Mental Health, 17(6), 667-678. Retrieved from https://doi.org/10.1080/13607863.2013.790926
- Viggo Hansen, N., Jørgensen, T., & Ørtenblad, L. (2006). Massage and Touch for Dementia. The Cochrane Database of Systematic Reviews, 2006(4), CD004989. Retrieved from https://doi.org/10.1002/14651858.CD004989.pub2
- Jimbo, D., Kimura, Y., Taniguchi, M., Inoue, M., & Urakami, K. (2009). Effect of Aromatherapy on Patients with Alzheimer’s Disease. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 9(4), 173–179. Retrieved from https://doi.org/10.1111/j.1479-8301.2009.00299.x
- Scuteri, D., Morrone, L.A., Rombolà, L., Avato, P.R., Bilia, A.R., Corasaniti, M.T., Sakurada, S., Sakurada, T., & Bagetta, G. (2017). Aromatherapy and Aromatic Plants for the Treatment of Behavioural and Psychological Symptoms of Dementia in Patients with Alzheimer’s Disease: Clinical Evidence and Possible Mechanisms. Evidence-Based Complementary and Alternative Medicine, 2017, ID:9416305. Retrieved from https://doi.org/10.1155/2017/9416305
- Gauthier, S., Cummings, J., Ballard, C., Brodaty, H., Grossberg, G., Robert, P., & Lyketsos, C. (2010). Management of Behavioral Problems in Alzheimer’s Disease. International Psychogeriatrics, 22(3), 346-372. Retrieved from https://doi.org/10.1017/S1041610209991505
- Watt, J.A., Goodarzi, Z., Veroniki, A.A., Nincic, V., Khan, P.A., Ghassemi, M., Thompson, Y., Tricco, A.C., & Straus, S.E. (2019). Comparative Efficacy of Interventions for Aggressive and Agitated Behaviors in Dementia: A Systematic Review and Network Meta-Analysis. Annals of Internal Medicine, 171(9), 633-642. Retrieved from https://doi.org/10.7326/M19-0993
Our Medical Affairs Team is a dedicated group of medical professionals with diverse and extensive clinical experience who actively contribute to the development of our content, products, and services. They meticulously evaluate and review all medical content before publication to ensure it is medically accurate and aligned with current discussions and research developments in mental health. For more information, visit our Editorial Policy.
MentalHealth.com is a health technology company guiding people towards self-understanding and connection. The platform provides reliable resources, accessible services, and nurturing communities. Its purpose is to educate, support, and empower people in their pursuit of well-being.
Naomi Carr is a writer with a background in English Literature from Oxford Brookes University.
Dr. Brittany Ferri, PhD, is a medical reviewer and subject matter expert in behavioral health, pediatrics, and telehealth.
Our Medical Affairs Team is a dedicated group of medical professionals with diverse and extensive clinical experience who actively contribute to the development of our content, products, and services. They meticulously evaluate and review all medical content before publication to ensure it is medically accurate and aligned with current discussions and research developments in mental health. For more information, visit our Editorial Policy.
MentalHealth.com is a health technology company guiding people towards self-understanding and connection. The platform provides reliable resources, accessible services, and nurturing communities. Its purpose is to educate, support, and empower people in their pursuit of well-being.